Ponton Rhys, Sawyer Richard
School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Br J Pain. 2018 Aug;12(3):171-182. doi: 10.1177/2049463717742420. Epub 2017 Nov 15.
Long-term opioid analgesic prescribing in chronic non-cancer pain (CNCP) is a growing worldwide concern. This has implications for optimal healthcare management in general and chronic pain management specifically. This work documents the development of a review tool and its use in the South West of England in a locality that showed opioid prescribing levels higher than surrounding localities.
An electronic tool which enabled calculation of total prescribed morphine-equivalent doses was developed to allow general practitioners (GPs) to undertake reviews of CNCP patients. This tool was used to assess strong opioid prescribing over a 3-month period at every GP practice (n = 41) in the locality. Every prescription for morphine, oxycodone, pethidine and fentanyl during this period was included.Aspects assessed included drug(s) prescribed, dose prescribed, whether tramadol was prescribed concurrently, whether the drugs were potentially being overused and/or whether the patient was in palliative care. Patients prescribed over 120 mg morphine equivalent per day were reviewed in greater depth, as this is an indication for specialist input.
In total, 1881 patients received a prescription in the assessment period. Morphine was the most commonly prescribed drug (n = 847). In all, 363 CNCP patients were prescribed a dose equal to or above 120 mg morphine a day, with a maximum morphine-equivalent dose of 890 mg being prescribed. Over 11% (n = 211) of patients were concurrently prescribed tramadol. The most frequently cited reason for prescription of high-dose opioids was found to be a musculoskeletal pain of the back, neck, joints or limbs. The care of 85 specific CNCP patients was reviewed and optimised.
No published work to date has documented such an in-depth analysis of primary-care opioid analgesic prescribing utilising prescriber data. Assessing total-dose morphine-equivalent prescribing using this method provides valuable insights into the potential need for urgent medication review. The tool developed may be of value to other GP practices following validation.
慢性非癌性疼痛（CNCP）的长期阿片类镇痛药物处方在全球范围内日益受到关注。这对整体最佳医疗管理，尤其是慢性疼痛管理具有重要意义。这项工作记录了一种审查工具的开发及其在英格兰西南部一个阿片类药物处方水平高于周边地区的地方的使用情况。
开发了一种电子工具，用于计算总处方吗啡等效剂量，以便全科医生（GP）对CNCP患者进行审查。该工具用于评估该地区每个全科医生诊所（n = 41）在3个月期间的强效阿片类药物处方情况。在此期间，包括吗啡、羟考酮、哌替啶和芬太尼的每一张处方。评估的方面包括所开药物、规定剂量、是否同时开具曲马多、药物是否可能被过度使用和/或患者是否处于姑息治疗中。每天开具超过120毫克吗啡等效剂量的患者接受了更深入的审查，因为这表明需要专科医生介入。
在评估期间，共有1881名患者接受了处方。吗啡是最常开具的药物（n = 847）。总共有363名CNCP患者每天开具的剂量等于或高于120毫克吗啡，开具的最大吗啡等效剂量为890毫克。超过11%（n = 211）的患者同时开具了曲马多。开具高剂量阿片类药物最常 cited 的原因是背部、颈部、关节或四肢的肌肉骨骼疼痛。对85名特定CNCP患者的护理进行了审查和优化。
迄今为止，尚无已发表的工作记录利用开处方者数据对初级保健阿片类镇痛药物处方进行如此深入的分析。使用这种方法评估总剂量吗啡等效处方，可为紧急药物审查的潜在需求提供有价值的见解。开发的工具在经过验证后可能对其他全科医生诊所有用。
